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Sick and Abandoned

It was the stuff of nightmares. Poisonous water moccasins were swimming in the filthy water of the flooded first floor, and snipers, rats and even a 12-foot alligator were roaming the treacherous area just outside the hospital's doors.

"To me, it was like being in hell," said Carl Warner, the chief engineer for Methodist Hospital in the hard-hit eastern part of New Orleans. "There were bodies floating in the water outside the building, and our staffers had to swim through that water to get fuel for the generator."

The patients and staff at Methodist could have been evacuated before Hurricane Katrina hit. But instead they were condemned to several days of fear and agony by bad decision-making in Louisiana and the chaotic ineptitude of the Federal Emergency Management Agency. Some of the patients died.

Incredibly, when the out-of-state corporate owners of the hospital responded to the flooding by sending emergency relief supplies, they were confiscated at the airport by FEMA and sent elsewhere.

The time to evacuate the hospital was when it became clear that New Orleans was in the path of a Category 4 or 5 hurricane. "We had about 137 patients," said Dr. Jeffrey Coco, the hospital's chief of staff, "and we had a company called Lifeguard that was going to take them out."

But apparently there was a reluctance to evacuate without some sort of governmental guidance. When the mayor of New Orleans, Ray Nagin, issued a mandatory evacuation order, hospitals were exempted. Dr. Fred Cerise, secretary of Louisiana's Department of Health and Hospitals, said Methodist officials could have decided on their own to evacuate, but that never happened.

Some of the patients were extremely ill, requiring ventilators or dialysis treatment or major surgery. When the hurricane hit, part of the roof blew off, windows were blown out, the atrium was badly damaged and the hospital was drenched with rain. On Monday night the power went out, and on Tuesday, after the levees broke, the first floor became hopelessly flooded.

By midweek you had a bizarre situation in which hundreds of people (patients, doctors, nurses, administrative staffers, relatives and people seeking emergency shelter) were stranded, cut off from the rest of the world, in a badly damaged hospital in a major American city.

Staffers with flashlights worked heroically in a sodden, stench-filled environment in which temperatures reached 110 degrees. Elevators did not work, and some patients weighing more than 400 pounds had to be carried up dark, reeking staircases. When ventilators shut down with the loss of power, volunteers worked in shifts to do the difficult hand-pumping necessary to keep patients alive.

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Nevertheless, according to Dr. Albert Barrocas, the chief medical officer, the decline in the well-being of the patients was both palpable and widespread. "All of them were deteriorating in the sense of becoming weak," he said. "You could see in their faces the fact that they were scared."

By Tuesday evening four patients had died, and a dozen were dead by the time the hospital was finally evacuated Friday. Doctors believe half of the deaths were caused by the dreadful conditions in the hospital.

Everybody's suffering would have been eased if the emergency relief effort mounted by the hospital's owner, Universal Health Services in King of Prussia, Pa., had not been interfered with by FEMA. Company officials sent desperately needed water, food, diesel fuel to power the hospital's generators and helicopters to ferry in the supplies and evacuate the most vulnerable individuals.

Bruce Gilbert, Universal's general counsel, told me yesterday, "Those supplies were in fact taken from us by FEMA, and we were unable to get them to the hospital. We then determined that it would be better to send our supplies, food and water to Lafayette [130 miles from New Orleans] and have our helicopters fly them from Lafayette to the hospital."

Significant relief began to reach the hospital on Thursday, and by Friday evening everyone had been removed from the ruined premises. They had endured the agonies of the damned, and for all practical purposes had been abandoned by government at all levels.

When you consider that the Methodist Hospital experience was just one small part of the New Orleans catastrophe, you get a sense of the size of the societal failure that we allowed to happen.

Welcome to the United States in 2005.

Op-Ed Columnist E-mail: bobherb@nytimes.com

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A version of this op-ed appears in print on September 15, 2005, on Page A00031 of the National edition with the headline: Sick And Abandoned. Today's Paper|Subscribe